ABSTRACT
This article is the second part of an interesting qualitative research project which presents and interprets opinions made by diverse medical and nursing professionals regarding care provided to terminal patients and relationships with patients' relatives.
Subject(s)
Attitude of Health Personnel , Attitude to Death , Death , Terminally Ill , Humans , Interviews as TopicABSTRACT
Objetivos: identificar dificultades y obstáculos de los profesionales médicos y enfermeros en relación con la sobreactuación terapéutica; explorar la diversidad de experiencias. Método: estudio cualitativo de tipo fenomenológico basado en entrevistas individuales a profesionales médicos y enfermeros que trabajan con enfermos terminales y familia, en hospitales y centros de salud de zonas urbanas y rurales de Granada y provincia, grabadas y transcritas, y asistidos en el análisis de la información por el software Atlas.tí, con una muestra de 42 entrevistas (20 médicos, 21 enfermeros y 1 psicólogo) sobre 48, y 6 rechazadas por no cumplir criterios de triangulación de la información. Resultados: aunque los profesionales son contrarios a alargar la agonía de los enfermos admiten que la presión que soportan de las familias les lleva a intervenir. Aparecen diferencias de posicionamiento y matiz entre profesionales en hospitales y en centros de salud, y entre profesionales médicos y enfermeros, sin embargo, para todos ellos, el trabajo con la familia es un problema. Conclusiones: desde la perspectiva del profesional, las demandas familiares condicionan la presencia de sobreactuación. Ausente la consideración de los deseos y opiniones de los pacientes en la toma de decisiones. Dificultades para reconocer la situación de enfermedad terminal y para transmitirla, así como identificar enfermo terminal y enfermo agónico explican comportamientos sobreactuantes. El trabajo con los familiares para acordar y consensuar medidas terapéuticas requiere un entorno de relación terapéutica que no se puede improvisar en el último momento (AU)
Objetive: to identify the difficulties and obstacles that professional doctors and nurses face in relation to therapeutic obstinacy. To explore experience diversity. Method: qualitative phenomenological research based on individual interviews (recorded and transcribed) to doctors and nurses working with terminally ill patients and their families in hospitals and health centers in the suburbs and rural areas of Granada and its province. The analysis of data has been supported by the Atlas.tí software. The sample consists of 48 interviews, 42 of them to 20 doctors, 21 nurses, and 1 psychologist; the remaining 6 were rejected because of unmet criteria for information triangulation. Results: despite the fact that professionals are opposed to prolonging the agony of patients, they recognize that pressure from family demands eventually leads them to intervene. Attitudes and stance show differences between professionals in hospitals and health centers, and between doctors and nurses. Nevertheless, working with patient families is a problem. Conclusions: from a professionals point of view, family requests condition the presence of therapeutic obstinacy. Patient wishes and opinions are not considered when a decision is to be made. There are difficulties in recognizing and reporting on illness status, as well as difficulties in identifying a terminally ill patient from an agonizing one. These difficulties explain obstinate behaviors. Working with families to arrange for therapeutic decisions requires a therapeutic relationship environment, which cannot be improvised at the last minute (AU)
Subject(s)
Humans , Terminally Ill/psychology , Right to Die , Professional-Family Relations , Decision Making , Physician-Patient Relations , Nurses/psychology , Palliative CareABSTRACT
La prevalencia de la hipertensión en España se sitúa en torno al 25% de la población adulta. Los profesionales de la salud disponen de un amplio arsenal terapéutico y conocen los criterios higiénico-dietéticos que mantendrían los niveles arteriales dentro de la normalidad. La falta de observancia de la pauta terapéutica es común en todo proceso crónico. En el caso de la hipertensión arterial las cifras de no cumplidores alcanzan límites realmente preocupantes, cerca del 40% para el tratamiento farmacológico y entre el 60-90% en las medidas higiénico-dietéticas. Por ahora, se sabe poco sobre las opiniones y expectativas que los pacientes tienen sobre la hipertensión y su tratamiento. Para tratar esta cuestión, hemos diseñado un estudio cualitativo basado en la técnica de los grupos focales. El objetivo ha sido identificar desde la perspectiva de los usuarios las dificultades del cumplimiento, así como los factores relacionados con este fenómeno. Constatamos la dificultad a la hora de seguir las prescripciones médicas, en gran medida porque no se sienten tratados de forma individualizada para establecer el tratamiento, las medidas adecuadas y el modo de llevarlo a cabo. Consideramos que es fundamental optimizar la relación del profesional de la salud con el paciente
The prevalence of hypertension among adults in Spain reaches around 25%. Health professionals have many therapeutic means at their disposal and know all hygienic and dietetic measures needed to keep arterial levels within normality. Non-adherence to therapy is a common observable fact in all chronic processes. Concerning arterial hypertension, non-adherence percentages reach alarming levels: nearly 40% non-adherence to drug treatment and between 60-90% non-adherence to hygienic and dietetic measures. So far, little is known about patients' expectations and opinions about hypertension and its treatment. To deal with this subject, a qualitative study was designed based on the focal groups' technique. The aim was to identify adherence difficulties according to patients, as well as other factors related to this phenomenon. We have detected treatment adherence difficulties, mainly due to a lack of individual treatments, measures and application methods. We believe it is essential for health professionals to optimize their relations with their patients
Subject(s)
Humans , Hypertension/drug therapy , Antihypertensive Agents/therapeutic use , Patient Compliance , Professional-Patient Relations , Blood Pressure Determination/methodsABSTRACT
The authors publish data which refer to a study carried out on a sample of 350 nursing professionals in the Granada hospital network, subdivided into two groups: a risk group (GR) and a non-risk group (NR). The authors analyze the results obtained relative to the presence of stress in situations of agony and death, as well as the family as an object for professional treatment in both study groups.
